Reducing Surgical Site Infections after Non-Hysterectomy Abdominal Gynecologic Surgery [25Q]

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Abstract

INTRODUCTION:

Surgical site infections (SSI) are common and a significant source of preventable morbidity in gynecologic surgery. Of the gynecological SSIs at our urban tertiary care safety-net hospital >50% had no indication for preoperative antibiotics based on current ACOG guidelines, which do not recommend antibiotics for abdominal surgeries outside of hysterectomy. In July 2016, we implemented a Quality Improvement (QI) initiative whereby Cefazolin was administered to all patients undergoing non-hysterectomy abdominal gynecologic surgery.

METHODS:

The purpose of this study is to perform a one-year interim analysis to assess whether pre-operative antibiotics administered for non-hysterectomy abdominal gynecologic surgery decreased the incidence of SSI as compared to a pre-intervention control group. The primary outcome was incidence of SSI, as defined by CDC guidelines. Data were collected on type of surgery, antibiotics, SSIs, and potential confounders for cases performed between November 2013 and June 2017 (n=507).

RESULTS:

The rate of SSI decreased after the implementation of the QI initiative from 7.5% (29/383) in the pre-intervention group to 3.2% (4/124) in the intervention group (P=.06). There was a significant decrease in the incidence of SSI from 8.5% (23/270) in patients that did not receive pre-operative antibiotics to 4.2% (10/237) in those that received pre-operative antibiotics (P=.03). Peri-operative variables associated with an increased incidence of SSI included increased surgical time, ASA class III and IV, and open vs laparoscopic surgical entry.

CONCLUSION:

The use of pre-operative antibiotics in non-hysterectomy abdominal gynecologic surgery resulted in a significant decrease in SSI incidence.

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